Transcript Electronic Data Interchange Assessment Strategies

Electronic Data Interchange
Assessment Strategies
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Application Systems
Trading Partners
Business Associates
Application Vendors
The Standards
Application System Modifications
Testing vs. Certification
Implementation
Application Systems
• What is an Application System?
• Inventory Application Systems
• Determine Owner
– In-house vs. Vendor Supported
• Assess Application System
– Transactions, Medical Code Sets, National
Identifiers
• Utilize ‘System Functionality Statement’ as a Starting Point
Trading Partners
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What is a Trading Partner?
Inventory Trading Partners
Review Trading Partner Agreements
Form New Trading Partner Agreements
WEDI/SNIP White Paper
http://snip.wedi.org/public/articles/Trading113000.pdf
Business Associates
• What is a Business Associate?
• Inventory Business Associates
• Review Business Associate Agreements
– Modify Agreements for HIPAA
• Form New Business Associate Agreements
• Follow-up with Business Associate
– Company HIPAA Statements and Status
– Compliance Strategies
Application Vendors
• Review Application Vendor Contracts
– Governmental Mandates
– Maintenance Fees
– Version Upgrade vs New Development
• Follow-up with Application Vendor
– Company HIPAA Statements and Status
– Compliance Strategies
The EDI Standards
• What is a Standard?
• Who has to use the Standards?
• When are the Standards Required?
The EDI Standards
• Health Care Eligibility Benefit Inquiry and Response
• ASC X12N 270/271 (004010X092)
• Health Care Claim Status Request and Response
• ASC X12N 276/277 (004010X093)
• Health Care Services Review Request and Response
• ASC X12N 278 (004010X094)
• Benefit Enrollment and Maintenance
• ASC X12N 834 (004010X095)
The EDI Standards
• Payroll Deducted and Other Group Premium Payment
for Insurance Products
• ASC X12N 820 (004010X061)
• Health Care Claim
– Institutional (UB92)
• ASC X12N 837 (004010X096)
– Professional (HCFA1500)
• ASC X12N 837 (004010X098)
– Dental
• ASC X12N 837 (004010X097)
• Health Care Claim Payment/Advice
• ASC X12N 835 (004010X091)
The EDI Standards
Washington Publishing Company
ANSI ASC X12N HIPAA
Implementation Guides
http://hipaa.wpc-edi.com/HIPAA_40.asp
Application System Modifications
• Assess Further at Data Element Level
– Compare Data Elements to the Standards
• Mandatory
• Situational
• Conditional
– Compare Data Element Attributes
– Numeric, Alpha, Alphanumeric, Size
– Review Business Needs
• ‘have’ vs. ‘don’t have’ vs. ‘cannot have’
Application System Modifications
• Determine Business Specifications
– How to do Business the HIPAA way
• Business and IT Unite
– IT cannot ‘Fix’ HIPAA
» Require Business Decisions
• Involve All Interested Parties
– Application System Users
» Management
» Worker Bees
Testing vs. Certification
“Those attempting to ‘self-certify’ are simply
testing themselves from beginning to end.”
• Testing
– Application Systems
• Internal
– Application to Application (A2A)
» Files, Program Code, Edits, Reports, Financials, etc...
• External
– Business to Business (B2B)
» Transactions
Testing vs. Certification
• Certification
– Electronic Healthcare Network Accreditation Commission
(EHNAC)
• http://www.ehnac.org/
– Claredi
• http://www.claredi.com
WEDI/SNIP White Paper
http://snip.wedi.org/public/articles/testing030901.pdf
Implementation
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Trading Partner Agreements In Place
Business Associate Agreement In Place
Application Systems HIPAA Compliant
Training Completed and Ongoing
Internal Testing Completed
External Testing Completed
HIPAA Transaction Certification Obtained
Now to the Second Phase